OUTCOME
We need to make hard
decisions about who we help
and who we don’t; that means
thinking about how much
beneﬁt is provided by diﬀerent
activities. The quality-adjusted
life year allows us to compare
the impact of diﬀerent
sorts of health programs.
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IMPACT
The very best health and
education programs are
hundreds of times better than
“merely” very good programs.
For example, smallpox
eradication did so much
good that it alone shows
development aid to be
highly cost-eﬀective on
average.
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NEED
Natural disasters get far more funding
than ongoing causes of death and
suﬀering such as disease; for that
reason, disaster relief usually isn’t the
most eﬀective use of funds. Diseases,
like malaria, that aﬀect people in the
developing world, get far less funding
than conditions like cancer; for that
reason you have a much bigger
impact treating people with
malaria than with cancer.
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INEVITABLE
This question helps us
to avoid trying to do
good works that would
happen with or without
our involvement.
In careers like medicine,
you’re sometimes simply
doing good work that
would have happened
anyway.
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REWARD
Some activities—such as
voting, entering politics,
campaigning for systemic
change, or mitigating risks of
global catastrophe—are
eﬀective not because they’re
likely to make a diﬀerence
but because their impact
is so great if they do
make a diﬀerence.
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